538-S
Claim for Credit/Refund of Sales Tax
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Instructions on reverse side. Please read carefully
Your Social Security Number
as an incomplete form may delay your refund.
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Spouse’s Social Security Number
Part 1: Taxpayer Information
Print first name, middle initial and last name (first name and middle initial of spouse)
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Check if you or your spouse have a physical disability
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constituting a substantial handicap to employment
(submit proof)
Present home address (number and street, including apartment number, or rural route)
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Check if you or your spouse are 65 years of age or over
City, State and Zip
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Live in Oklahoma for the entire year?
yes
no
Physical Address during 2006 (if different than above)
Oklahoma resident for the entire year? yes
no
Part 2: Dependent and Exemption Information
Qualified Exemptions...
See Instructions
1. Dependents
5.Yearly
(first name, initial, last name) If you have
2. Age 3. Social Security Number
4. Relationship
Income
A. Yourself ............................
additional dependents, please attach schedule.
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B. Spouse ............................
C. Number of your
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dependent children ..
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D. Number of other
dependents .............
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E. Total exemptions
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claimed (add A-D) ..
Part 3: Gross Income:
Enter gross income and assistance, taxable and nontaxable, received by ALL members of your household in the year 2006.
See “Total household income” definition on back for examples of income.
Yearly Income
You may not enter negative amounts.
1.
Enter total wages, salaries, fees, commissions, bonuses, and tips
(including nontaxable income from your W-2s) .........................................................................
1
00
2
2.
Enter total interest and dividend income received .....................................................................
00
3.
Total of all dependents' income (from Part 2, column 5) ............................................................
3
00
4.
Social Security payments (total including Medicare) .................................................................
4
00
5
00
5.
Railroad Retirement benefits .....................................................................................................
6.
Other pensions, annuities and IRAs ..........................................................................................
6
00
7.
Alimony ......................................................................................................................................
7
00
8
00
8.
Unemployment benefits .............................................................................................................
9.
2005 Earned Income Credit (EIC) received in 2006 and Advanced EIC received in 2006.........
9
00
10.
Nontaxable sources of income (specify) ________________________________ ...................
10
00
You may not enter negative amounts.
11.
Enter gross (positive) income from rental, royalties, partnerships, estates & trusts, and gains
from the sale or exchange of property
...
11
00
(taxable & nontaxable) (enclose Federal return including schedules)
12.
Enter gross (positive) income from business and farm
.....
12
00
(enclose Federal return including schedules)
13.
Other (specify) _____________________________________ ...............................................
13
00
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14.
Total gross household income (Add lines 1-13) .........................................................................
14
00
If line 14 is over income limits shown in steps 3 and 4 on back of this form, no credit is allowed.
Part 4: Sales Tax Credit Computation
(For households with gross income below allowable limits, see steps 3 and 4 on back of form.)
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15.
Total qualified exemptions claimed in Box E above
x $40 (credit claimed) ..........
00
15
I f you are filing a Form 511, carry
the credit to Form 511, line 27.
Direct Deposit Option:
If you would like to have the amount shown on line 15 deposited directly into your
(for those not filing a Form 511)
checking or savings account, please complete
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Yes! Please deposit my refund in my
checking account
savings account
this “Direct Deposit Option” section.
Routing
Account
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Number:
Number:
Under penalty of perjury, I declare that the information contained in this document and any attachments is true and correct to the best of my knowledge and belief.
If the Oklahoma Tax Commission may discuss this return
with your tax preparer, please check here:
Taxpayer’s Signature and Date
Spouse’s Signature and Date
Preparer’s Signature and Date
Occupation
Occupation